The Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered by Medicare. These changes are updated via national coverage determinations (NCDs).
CMS has issued the following NCDs:
Implementation Date: January 4, 2027
The Centers for Medicare & Medicaid Services (CMS) advised that effective June 8, 2026, non-invasive biomarker screening tests are appropriate colorectal cancer screening tests based on specific criteria.
Non-Invasive Biomarker tests are covered once every three years under the following conditions
A. Ordering Criteria
- When ordered by the physician, physician assistant, nurse practitioner, or clinical nurse specialist who will use the results in the management of the patient
B. Patient Criteria
- Age 45 to 85 years; and,
- Asymptomatic (no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive non-invasive biomarker colorectal cancer screening test); and,
- At average risk of developing colorectal cancer (no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis; no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer); and,
- Provided with information about the test performance and the importance of a follow-on colonoscopy if the test returns a positive result.
C. Test Criteria
- The test must be Food and Drug Administration (FDA) market authorized and indicated for colorectal cancer screening; and,
- The test must achieve the requirements of the FDA-required post-approval study as specified in the Safety and Effectiveness Data (SSED) to continue coverage; and
- The test must be processed in a Clinical Laboratory Improvement Amendment (CLIA) certified laboratory; and,
- The test must demonstrate performance characteristics that meet EITHER Criteria1, a sensitivity of greater than or equal to 90% and a specificity greater than or equal to 87%, OR Criteria 2, a sensitivity of greater than or equal to 79% and a specificity of greater than or equal to 90% in the detection of colorectal cancer compared to the recognized standard (accepted as colonoscopy at this time), based on the FDA labeling.
Effective Date: October 28, 2025: CMS Transmittal - NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension
Updated 2/16/2026
Transmittal 13612 issued January 30, 2026, is being rescinded and replaced by Transmittal 13640, dated February 13, 2026, to include the correct version of the NCD 20.40 Renal Denervation for Uncontrolled Hypertension Spreadsheet, where principal language for ICD-10 CM codes is removed. This correction does not make any revisions to Pub. 100-03.
All other information remains the same.
Updated 2/2/2026:
Transmittal 13522 issued December 11, 2025, is being rescinded and replaced by Transmittal 13612, dated January 30, 2026, to update Transmittal Pub. 100-04 Business Requirements (BRs) to include outpatient Type of Bill (TOB) and Place of Service (POS). The BRs will be revised to ADD this setting and modify associated BRs editing to be performed in the correct setting. Clarifying language has also been updated for ICD-10 diagnosis codes. The associated changes will be made in the claims processing manual and updated in the NCD spreadsheet. Additionally, BR 14302-04.13 has been added. This correction does not make any revisions to Pub. 100-03
All other information remains the same.
CMS advised that effective October 28, 2025, there is coverage for radiofrequency renal denervation (rfRDN) and ultrasound renal denervation (uRDN) (collectively, RDN) for uncontrolled hypertension under Coverage with Evidence Development (CED) according to the criteria outlined in NCD manual, Chapter 1, Section 20.40.
Consistent with section 1142 of the Act, the Agency for Healthcare Research and Quality (AHRQ) supports clinical research studies that CMS determines meet all the criteria and standards identified above.
Renal denervation (RDN) for uncontrolled hypertension) is not covered for patients outside of a CMS approved study.
Effective Date: October 28, 2025: CMS Transmittal - Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Effective October 28, 2025, CMS covers CCM used for the treatment of HF under Coverage with Evidence Development (CED) according to the criteria outlined in the National Coverage Determination (NCD) manual, chapter 1, section 20.39. Consistent with section 1142 of the Act, Agency for Healthcare Research and Quality (AHRQ) supports clinical research studies that CMS determines meet all the criteria and standards identified above. CCM used for the treatment of HF is not covered for patients outside of a CMS-approved study. Nothing in this NCD would preclude coverage of CCM through NCD 310.1 (Clinical Trial Policy) or through the Investigational Device Exemption (IDE) Policy.
Effective October 1, 2025: CMS Transmittal - Billing Code Clarification for National Coverage Determination (NCD) 210.13 Screening for Hepatitis C Virus (HCV) in Adults
CMS issued a transmittal clarifying that shared system maintainers need to update their hard code editing to allow compliance when billing a HCPCS code (G0567) to be payable under NCD 210.13.
Effective July 2, 2025: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (TTEER)
The Centers for Medicare & Medicaid Services (CMS) covers Transcatheter Edge to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER) under Coverage with Evidence Development (CED) according to the criteria outlined in the National Coverage Determination (NCD) manual, Chapter 1, Section 20.38.
Effective Date: June 26 2025: CMS Transmittal - Removal of Chimeric Antigen Receptor (CAR) T-cell Therapy and Risk Evaluation Mitigation Strategy (REMS) – NCD 110.24 and the “KX’ Modifier for CAR-T Cell Therapy Claims
The Centers for Medicare and Medicaid Services (CMS) is amending the claims processing instructions (Claims Processing Manual 100-04, Chapter 32, Section 400) for Chimeric Antigen Receptor (CAR) T-cell therapy and clarify that the Risk Evaluation and Mitigation Strategy (REMS) requirement in the National Coverage Determination (NCD) 110.24 for Chimeric Antigen Receptor (CAR) T-cell Part A and Part B requirements have been updated.
Effective: June 9, 2025: CMS Transmittal 13374 - Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
The Centers for Medicare & Medicaid Services (CMS) advised that effective June 9, 2025, there is coverage for Respiratory Assist Device (RADs) with or without a backup rate feature and Home Mechanical Ventilators (HMVs), in the home, as treatment for patients with Chronic Respiratory Failure (CRF) consequent to Chronic Obstructive Pulmonary Disease (COPD).
Effective: October 20, 2023: CMS Transmittal - Update to Claims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
Updated 2/16/2026
Transmittal 13483 issued December 05, 2025, is being rescinded and replaced by Transmittal 13641, dated February 13, 2026, to update Chapter 32, section 270.1 of the Claims Processing Manual to remove diagnosis codes I47.10, I47.11 and I47.19 that was erroneously added to Group 1 ICD-10 diagnosis codes. These codes are only applicable under Group 2 ICD-10 diagnosis codes. Change the effective date from September 30, 2023, to October 1, 2023, for the Group 2 codes. This correction also updates the NCD 20.4 Implantable Cardiac Defibrillators (ICDs) spreadsheet.
All other information remains the same.
CMS advised that initially only intravascular ICD systems were available, however, in October 2023, the FDA approved the Aurora™ extravascular ICD (EV-ICD) system, with its pivotal clinical trials concluding in 2024. The following procedure codes are payable for Aurora™ extravascular ICD (EV-ICD) system and added to the list of codes for ICD systems:
- 0571T – Insertion or replacement of an implantable cardioverter-defibrillator (ICD) system with substernal electrode(s), including all imaging guidance and electrophysiological evaluation (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters), when performed
- 0572T – Insertion of substernal implantable defibrillator electrode
- 0573T – Removal of substernal implantable defibrillation electrode
- 0574T – Repositioning of a previously implanted substernal implantable defibrillator-pacing electrode
- 0575T- Programming device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional · 0576T- Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter
- 0577T- Electrophysiological evaluation of implantable cardioverter-defibrillator system with substernal electrode (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
- 0578T- Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
- 0579T- Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
- 0580T- Removal of substernal implantable defibrillator pulse generator only
- 0614T- Removal and replacement of substernal implantable defibrillator pulse generator